Health care enrollment ready to be tested

Oct. 1, 2013

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Special report

The Affordable Care Act will touch nearly every American. As key parts of the complex law begin to take effect, Gannett Wisconsin Media is examining the most important issues for consumers, in a series called “Health Care Reform & You.” The stories focus on helping you understand what you need to do, how to do it and how to get help. Installments in the series mostly appear on Sundays and Mondays, but we’re also reporting on related news developments as they happen. For more information about the changes and to read past stories, visit greenbaypressgazette.com/healthcarereform.

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Join AyLee Her, a health care enrollment and outreach specialist at Bridge Community Health Clinic in Wausau, to discuss the Affordable Care Act at noon on Wednesday. Click on greenbaypressgazette.com/healthcarereform. Submit questions on Twitter using the hashtag #WIACA., on Facebook at

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A key date for the landmark Affordable Care Act arrives today when health insurance exchanges open to consumers for enrollment. One of the great obstacles for Wisconsinites: a public awareness gap.

Wisconsin ranked the lowest in spending among the 50 states toward outreach, advertising and marketing, according to an Associated Press report. Gov. Scott Walker has strongly opposed the federal health care insurance overhaul.

However, state government officials and nonprofit leaders say those burdened with questions and confusion on the changes and requirements for their own health insurance needs will have plenty of outlets to find guidance.

“We’re as ready as we can be,” said Laura Scudiere, executive director of Wausau’s Bridge Community Health Clinic.

Low-income residents can buy insurance through a website — referred to as a marketplace — from today through March 31. The law requires most individuals to have health coverage as of Jan. 1. Enrollment is open through the end of March, but individuals need to enroll and pay the first month’s premium by Dec. 15 to have coverage by Jan. 1.

The federal government set up the website, healthcare.gov, where consumers can compare plans, determine possible government subsidies and sign up.

Need for help

John Rathman, deputy director of the Outagamie County Health Department, expects many people will need a lot of help navigating the system. Some lack computer literacy. Some lack basic knowledge of insurance and will be intimidated. Those with disabilities also will need help.

“The marketplace was really designed to help middle class families,” he said. “It wasn’t designed for low-income individuals and those with greater challenges, and that’s a challenge we face.”

In July, Wisconsin organized 11 regional enrollment networks to serve as a safety net. Each multi-county network is comprised of a variety of entities — from public health departments and community clinics to advocacy groups. Meetings held in August and early September included representatives from hospitals, health maintenance organizations and insurance agencies.

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Officials say the structure of the enrollment networks allows for information to be consistently spread across all regions of the state, while giving each region room to tailor to the needs of its residents.

Wisconsin had about 555,000 uninsured people — or 11.3 percent of the state’s residents — before the law took effect in 2010, according to the nonpartisan Kaiser Family Foundation. About half are expected to gain coverage.

Leaders say the next two months are critical given accompanying changes to eligibility to the state’s BadgerCare — a program that serves mostly low-income families, disabled residents and pregnant women.

Those who lose BadgerCare and don’t sign on quickly to the marketplace could run into difficulty should their prescriptions run out after Jan. 1 or their medical appointment dates arrive.

“I worry that people are frustrated and don’t know what to believe, and that could impact their willingness to move forward,” said Stacker, the Fox Valley community health center director.

Joan Theurer, director of the Marathon County Health Department, said groups beyond traditional health care entities will play an important part in identifying and aiding those with the greatest barriers, whether its language or inadequate computer skills. Marathon County is relying on groups such as its UW Extension office and its Hmong association to get the word out.

“We’re empowering our service providers to make those connections,” Theurer said.

Libraries also are playing a role.

Louanne Crowder, supervisor of reference at the Brown County Central Library in Green Bay, said her library has information sheets available, though its biggest contribution will likely come in the form of free Internet access.

She suspects most libraries that place time limits on users’ computer access will waive them for the purpose of health insurance enrollment.

High demand for helpers

Nonprofit leaders suspect that those being trained to provide assistance will be in high demand.

The federal government provided money for so-called “navigators” to assist consumers in applying and selecting plans through the health insurance exchanges. Grants, however, went to just six Wisconsin agencies, meaning those driving enrollment in many portions of the state had to find and pay for their own ways of providing help.

Communities will fill that gap with helpers referred to as “certified application counselors.” These trained individuals will be able to assist with enrollment, but will not be able to offer advice on selecting coverage.

J.P. Wieske, spokesman for the state Office of the Commissioner of Insurance, which is coordinating Wisconsin’s efforts, said the agency has trained more than 400 people to serve as counselors. Others have undergone private training to obtain certification.

Claire Smith, a spokeswoman for the Wisconsin Department of Health Services, is confident the state’s infrastructure for navigating the transition is strong although the work is just beginning.

“We’re trying to do everything we can, through working with our community partners, to make this as smooth of a transition as possible.”